Xa uhamba ngexesha elivumelekileyo lemali kwi-inshorensi yempilo yakho yeenzuzo , kunokubangela ukudideka. Imali iyonke inani lakho inkampani yomshuwalense wezempilo iyicinga ukuba umniki-nkonzo wakho wezempilo uyakuhlawulwa ngokunyamekela kwakhe. Inani elivunyelweyo lilawulwa ngokwahlukileyo xa usebenzisa umnikezeli we -inethiwekhi kunokuba usebenzise umnikezeli we- out-of-network .
Inani elivunyelweyo kunye noNakekelo lweNethiwekhi
Ukuba uthe wasebenzisa umboneleli onxibelelwano kunye nesicwangciso sakho sezempilo, isixa esivumelekileyo sixabiso elihlawulelweyo isicwangciso sakho sezempilo sokunakekelwa esilungelelaniswe kwangaphambili kule nkonzo. Ngamanye amaxesha umniki-intanethi uya kuhlawula ngaphezu kwexabiso elivumelekileyo, kodwa uya kuhlawulwa kuphela imali evumelekileyo. Awunayo impahluko phakathi kwemali evumelekileyo kunye nemali ekhoyo ehlawulwayo xa usebenzisa umnikezeli wenethiwekhi. Enye yokhuseleko lwabathengi oluza kunye nokusebenzisa umniki-inethiwekhi.
Nangona kunjalo, oku akutsho ukuba awuyi kuhlawula nto. Uhlawula isahlulo semali esivumelekileyo isixa semali ye- copayment , i- coinsurance , okanye i- deductible . Umshuwalense wakho wezempilo uhlawula lonke ixesha elivumelekileyo.
Naliphi na into ehlawulweyo ngaphezulu nangaphezulu kwexabiso elivunyelweyo akuvumelekanga. Umboneleli wezempilo uya kuhlawulwa. Ukuba i-EOB yakho inekholomu yemali engavumelekanga, oku kubonisa isaphulelo kwenkampani yomshuwalense wezempilo exoxisana nomboneleli wakho.
Inani elivunyelweyo kunye noKhathalelo lwangaphandle lweNethiwekhi
Ukuba usebenzisa i-out-of-network, umrhumo ovumelekileyo yinkcitho yakho yenkampani yomshuwalense yezempilo yenze isigqibo sokuba ngumrhumo oqhelekileyo, wesiko kunye neengqiqo kule nkonzo. Umnikezeli-ngaphandle wenethiwekhi unako ukuhlawula nayiphi na imali ayithandayo. Isicwangciso sakho sezempilo asinesivumelwano kunye nomnikezeli-ngaphandle wenethiwekhi, ngoko akukho saphulelo esixoxwa ngaso.
Ingakanani isicwangciso sakho sezempilo esiza kuhlawula siya kusekelwe kwisixa esivumelekileyo, kungekhona kwixabiso elihlawulisiweyo.
Ngomniki-ntanethi ongaphandle, umgcini-mali uya kubala uhlalutyo lwakho olusekelwe kwisixa esivumelekileyo, kungekhona imali ehlawulweyo. Uya kuhlawula nayiphina i-copay, i-coinsurance, okanye i-out-of-network echithwayo ngenxa; i-insurer yakho yempilo iya kuhlawula lonke inani elivunyelweyo.
Indlela umniki-ngaphandle wenethiwekhi olawula ngayo inxalenye yesibhambathiso esingaphantsi nangaphezulu kwexabiso elivunyelweyo liyahluka. Kwezinye iimeko, ngokukodwa xa uthe waxoxisana kwangaphambili, umniki-mali uya kulukhupha le mali. Kwezinye iimeko, umniki-mboleko uya kukubhatala ukuba uhluke phakathi kwemali evumelekileyo kunye neentlawulo zangaphambili. Oku kuthiwa ibhalansi yokuhlawula kwaye inokukubiza kakhulu.
Kutheni abatyhuseli bempilo banikezela imali evumelekileyo yokunakekelwa kwe-out-of-network? Yindlela yokunciphisa ingozi yemali. Ekubeni izicwangciso zempilo azikwazi ukulawula iindleko ze-intanethi kunye nezaphulelo ezingaphambi kokuxoxisana, kufuneka zilawule ngokunika umda ophezulu kumthetho-mthetho.
Masithi isicwangciso sakho sempilo sifuna ukuba uhlawule i-50% ye-coinsurance yokunakekelwa kwe-out-of-network. Ngaphandle kwesivumelwano esithengiweyo ngaphambili, umniki-ntanethi angaphandle angakhokhela i-$ 100,000 kwi-ofisi elula yokutyelela.
Ukuba isicwangciso sakho sezempilo asizange sibone isixa esivumelekileyo, kuya kuba nzima ukuhlawula i-$ 50,000 ukutyelela i-ofisi okuqhele ukuba ixabise i-$ 250. Isicwangciso sakho sezempilo sizivikela kulo mzekelo ngokunika inani elivumelekileyo kwiinkonzo zangaphandle.
Ngelishwa, ekuzikhuseleni kwiintlawulo ezingenangqiqo, iguqula umthwalo wokujongana nalezo zityholo ezingenangqiqo kuwe. Oku kungonakaliseki ngokucacileyo kokufumana unonophelo lwangaphandle-nethiwekhi kwaye isizathu sokuba uhlale uxoxisana neentlawulo zokunakekelwa ngononophelo kwangaphandle.